THE WHITE HOUSE
Office of the Press Secretary
_________________________________________________________________
For Immediate Release December 11, 2000
December 11, 2000
MEMORANDUM FOR THE SECRETARY OF AGRICULTURE
THE SECRETARY OF HEALTH AND HUMAN SERVICES
SUBJECT: Improving Immunization Rates for Children
at Risk
In 1992, less than 55 percent of children under the age of 3 nationwide had
received the full course of vaccinations. This dangerously low level of
childhood immunizations led me to launch, on April 12, 1993, the Childhood
Immunization Initiative, which helped make vaccines affordable for
families, eliminated barriers preventing children from being immunized by
their primary care provider, and improved immunization outreach. As a
result, childhood immunization rates have reached all-time highs, with 90
percent or more of America's toddlers receiving the most critical vac-cines
by age 2. Vaccination levels are nearly the same for preschool children of
all racial and ethnic groups, narrowing a gap estimated to be as wide as 26
percentage points a generation ago.
Despite these impressive gains, immunization levels in many parts of the
country are still too low. According to the Centers for Disease Control and
Prevention, low-income children are less likely to be immunized than their
counterparts. In fact, immunization rates in certain inner-city areas are
as low as 65 percent, placing them at high risk for potentially deadly
diseases such as diphtheria, pertussis, poliomyelitis, measles, mumps, and
rubella. These diseases are associated with birth defects, paralysis,
brain damage, hearing loss, and liver cancer. In addition, children who are
not fully immunized are proven to be at increased risk for other
pre-ventable conditions, such as anemia and lead toxicity. Clearly, more
needs to be done.
Today, I am directing you to focus your efforts to increase immunization
levels among children at risk in a place where we clearly can find them:
the Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC). This program, which serves 45 percent of infants nationwide and
more than 5 million children under the age of 5, is the single largest
point of access to health services for low-income preschool children who
are at the highest risk for low vac-cination coverage. State data
indicates that in 41 States, the immuni-zation rates for children enrolled
in WIC are lower than the rates for other children in their age group -- in
some cases, by as much as 20 percent.
Therefore, I hereby direct you to take the following actions, in a manner
consistent with the mission of your agencies:
(a) Include a standardized procedure as part of the WIC certification
process to evaluate the immunization status of every child applying
for WIC services using a documented immunization history. Children
who are determined to be behind schedule on their immunizations or who
do not have their immunization records should be referred to a local
health care provider as appropriate;
(b) Develop user-friendly immunization materials designed to ensure that
information on appropriate immunization schedules is easily accessible
and understandable for WIC staff conducting nutritional risk
assessments. WIC staff should be trained to use these materials by
State and local public health authorities;
(c) Develop a national strategic plan, within 60 days, to improve the
immunization rates of children at risk. In developing the plan, the
Departments of Agriculture and Health and Human Services should:
consult with repre-sentatives from the Office of Management and Budget
to ensure con-sidera-tion for the FY 2002 budget; include input from
provider, health care consumer, and nutrition communities, and develop
a blueprint for action to:
1. expand the availability of automated systems or computer software
to provide WIC clinics with information on childhood immunization
schedules, with the eventual goal of providing this service in
every WIC clinic nationwide, to provide more accurate and
cost-effective immunization assessment, referral, and follow-up,
in a manner that addresses cost-sharing concerns by both
agencies;
2. disseminate a range of best practices for increasing immunization
rates for low-income children to WIC State and local agencies, as
well as immunization programs nationwide, including developing
efficient and effective ways to educate WIC staff about the
importance of immunization, appropriate immunization schedules,
and the information necessary to make a meaningful referral;
3. foster partnerships (through written guides and/or technical
assistance) between WIC offices and health care
providers/advocates who can assist with immunization referrals
and conduct appropriate follow-up with families;
4. include information on the importance of immunizations and
appropriate immunization schedules in standard WIC efforts to
educate families about breastfeeding, anemia, lead poisoning, and
other health-related topics; and
5. evaluate whether other Federal programs serving children should
require a standard question on immunizations as part of their
enrollment process, and if deemed appropriate, develop a plan for
implementing that requirement.
The actions I am directing you to take today, and any further actions
developed as a result of interagency collaboration or public-private
partnerships, should not create barriers to WIC participation.
Immunization outreach and assessment procedures should never be used as a
condition of eligibility for WIC services or nutritional assistance.
Rather, activities to improve immunization rates for children participating
in WIC should be complementary, aggressive, and consistent with my
Administration?s overall initiative to increase immunization rates for
children nationwide.
WILLIAM J. CLINTON
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